CHRISTY HOFER
COPRUS CHRISTI,TEX
Summary
Pragmatic Insurance Verification Specialist touting 8 years of expertise in benefits explanation and coverage tracking. A team player with a vast knowledge of medical terms and working with all types of personalities effectively. Offering dynamic organizational skills and attention to detail.
Overview
8
8
years of professional experience
Work History
Insurance Verification Specialist
Christus Spohn Hospital-Shoreline
12.2022 - Current
- Verify health insurance using Ecare and One Source
- Enter insurance in patient chart in MediTech using various Iplans
- Running reports in MediTech for start of day work/end of day landscape/conversion reports
- Submitting authorizations either online or via telephone using diagnosis codes/CPT codes for Inpatient/Observation admissions. Providing Utilization Management contact information for need of clinical documentation.
- Answer emails from Care Management with patient plans to either convert to inpatient or observation status, and to submit insurance, if authorization is required.
- Answer phone calls in phone tree for various insurance companies needing to know if patient has discharged and disposition, so authorization request can be completed.
- Daily follow-up on pending authorizations via telephone or insurance portals.
- Daily accounts dispersed between insurance verification team, timely submissions must be completed by end of day.
- Common insurances worked with are Aetna, BCBS TX (and out of state plans), Superior (Medicaid/Medicare Plans), Driscoll, VA, Tri Care, Medicare and various others.
- Complied with HIPAA guidelines and regulations for confidential patient data.
Referral & Precertification Specialist
St Lukes Cardiovascular Consultants
06.2019 - 09.2022
- Track incoming physician referrals by urgency from work queue and addressed to meet established timelines.
- Familiar with cardiology tests and procedures along with medical terminology.
- Submit appeals and setting up peer to peer for physicians with insurances.
- Scan pertinent patient demographics and records in EMR to submit to insurance for approval of requested testing.
- Use Right Fax for faxing clinical documentation to insurance or third-party vendor such as Evicore, Availity, HealthHelp, etc.
- Knowledge of CPT codes and ICD-10 diagnosis codes
- Citrix, Epic, Right Fax software experience.
- Mitel phone system answering calls from patients, physicians, clinical staff, schedulers about testing authorizations.
- Working out of work queue with self-motivation.
- Deliver and excellent service experience with friendly, compassionate, and helpful demeanor.
- Maintain good working relationship with co-workers and management.
- Weekly "huddle" via WebEx with pre cert team and manager to discuss any issues or concerns.
REFERRAL PRECERTIFICATION SPECIALIST
LIBERTY CARDIOVASCULAR SPECIALIST
11.2016 - 06.2019
- Sending out referrals to doctor offices with patient demographics, any recent testing and office visit notes.
- Receive testing orders from physicians for processing through insurance with correct CPT codes and valid diagnosis codes by checking LCD's of Medicare and other commercial insurance companies.
- Verifying that procedure and diagnosis meet certain insurance guidelines, if not must contact physician to review current symptoms patient is having to determine if other options are more suitable.
- Contact insurance by phone or if possible, do pre authorizations online.
- Answered phone calls and messages for 12 Cardiology physicians/ Physician Assistants medical facility, scheduling appointments, and handling patient inquiries
Front Desk Medical Receptionist
LIBERTY CARDIOVASCUALAR SPECIALIST
02.2016 - 11.2016
- Front desk duties include answering phones, scheduling patients appointments, checking in/out patients, scanning in ID's and insurance cards, verifying HIPPAA forms are filled out in completion.
- Checked patient insurance, demographic, and health history to keep information current.
- Helped patients complete necessary medical forms and documentation.
- Organized paperwork such as charts and reports for office and patient needs.
- Verified and updated demographic and other personal information for clients with respect to personal boundaries when asking for important details.
- Kept waiting room neat and organized by stacking magazines, removing trash, and cleaning glass.
- Remained aware of provider schedules and scope of practice on evolving basis to organize and schedule appropriate care.
- Completed clerical duties and tasks for clinic administration.
- Transcribed phone messages and relayed to appropriate personnel.
- Notified manager of incidents and potential incidents relating to patients and staff for swift action.
- Obtained payments from patients and scanned identification and insurance cards.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Greeted visitors and initiated triage processes for clients to streamline patient flow.
Registered Pharmacy Technician
AnR Compounding Pharmacy
07.2015 - 02.2016
- Answering multiple phone lines
- Gathering patient information including name, address, phone, drug allergies, verifying if currently taking blood thinners such as Coumadin (warfarin) prescription insurance plan, Doctor name and contact information, prescription of what type of compound needed.
- Entering information into computer data base
- Contacting doctor to obtain prescription, whether it is for Pain cream or Hormone Replacement Therapy
- Taking new prescriptions and /or transferring prescriptions.
- Processing of prescription to insurance companies, calling insurance company to clarify what ingredients are covered.
- Entering payment information into QuickBooks system.
Education
High School Diploma -
Emporia High School
Emporia, KSSkills
- Data Verification
- Prior Authorization Processing
- Insurance Plan Verification
- Medical Terminology
- Electronic Authorization Processing
- Insurance Terminology
- Teamwork and Collaboration
- Insurance Authorizations
Timeline
Insurance Verification Specialist
Christus Spohn Hospital-Shoreline
12.2022 - Current
Referral & Precertification Specialist
St Lukes Cardiovascular Consultants
06.2019 - 09.2022
REFERRAL PRECERTIFICATION SPECIALIST
LIBERTY CARDIOVASCULAR SPECIALIST
11.2016 - 06.2019
Front Desk Medical Receptionist
LIBERTY CARDIOVASCUALAR SPECIALIST
02.2016 - 11.2016
Registered Pharmacy Technician
AnR Compounding Pharmacy
07.2015 - 02.2016
High School Diploma -
Emporia High School
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